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Things We Do for No Reason™: Prescribing gabapentinoids for pain.
Niti G Patel1, David Goese1, Steven M Belknap2
1Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Journal of Hospital Medicine
|February 16, 2026
Summary
Gabapentin and pregabalin offer limited benefits for off-label pain but carry significant risks like sedation and misuse. Deprescribing and non-drug therapies are recommended over routine opioid substitution.
Area of Science:
- Pharmacology
- Clinical Medicine
- Pain Management
Background:
- Gabapentin and pregabalin are frequently prescribed in the U.S.
- Most prescriptions are for off-label pain indications, exceeding FDA-approved uses.
Purpose of the Study:
- To evaluate the efficacy and safety of gabapentinoids for off-label pain management.
- To provide guidance on appropriate clinical use and alternatives.
Main Methods:
- Review of randomized controlled trials on gabapentinoids for pain.
- Analysis of adverse events and risks associated with gabapentinoid use.
Main Results:
- Randomized trials demonstrate minimal or clinically insignificant benefits for most off-label pain syndromes.
- Gabapentinoids are linked to adverse effects including sedation, falls, delirium, and respiratory depression.
- Risks are amplified when used with opioids or in patients with renal impairment.
Conclusions:
- Limited efficacy and significant harms suggest gabapentinoids should not routinely replace opioids.
- Clinicians should reassess indications, consider deprescribing, and prioritize nonpharmacologic pain management strategies.
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